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Acute stress reaction
This is an acute reaction which occurs rapidly (minutes to hours) after a sudden and stressful event.
– This can include sexual assault, an injury, a near-death experience etc.
– This leads to several symptoms in response which usually arise very quickly and terminate within 3 days
Symptoms:
– Initial state of being dazed and confused
– Purposeless overactivity and withdrawal
– Intense brief anxiety
– Autonomic arousal –> sweating, dry mouth, vomiting
Management – Help patient to re-orientate with trauma-focussed CBT
Prognosis – Most cases resolve rapidly within 3 days. If symptoms persist > 1 month, leads to PTSD
Post-traumatic stress disorder (PTSD)
This is a chronic condition that occurs following a traumatic event e.g. sexual assault, near death experience
– These events get stored as emotionally charged memories which the patient re-experiences
Symptoms – These must be present >1 month
– Persistent intrusive thoughts and re-experiencing –> flashbacks, nightmares and intrusive images
– Autonomic hyperarousal –> persistent activation gives startle, hypervigilance, insomnia
– Avoidance –> patient avoids situations and stimuli associated with the event
– Emotional detachment –> feeling detached from people and lack of ability to experience feelings
– Higher risk of depression, substance misuse, unexplained physical symptoms
Management:
– 1st line is trauma-focused CBT (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy
– The aim is to recall these memories and emotionally resolve them
Adjustment disorder
This is a condition which encompasses the abnormal psychological symptoms which occur in response to life adversity (e.g. job loss, divorce etc.)
– Symptoms occur within weeks of a stressful life events and last < 6 months
– The symptoms mimic those of anxiety and depression, but they are of lower severity and the patient will typically overcome them within 6 months
Symptoms:
– Anxiety –> autonomic arousal, insomnia, hypervigilance
– Depression –> sadness, tearfulness, anhedonia, fatigue
Diagnosis
– Only made when symptoms are not enough to justify diagnosis of anxiety or depression
Management:
– 1st line is encouraging ventilation of feelings and making problem-solving strategies
– 2nd line is CBT
Abnormal Grief Reaction
This is an adjustment disorder which specifically occurs after a bereavement
– It is characterised by a prolonged grief of greater intensity than would occur in other people
– People are left feeling numb, shocked and confused about their role in their life.
Normal grief occurs in 5 stages: Shock and disbelief –> Anger –> Guilt –> Sadness –> Acceptance
– This last <2 years and does not require specific management other than support.
In abnormal grief reaction, grief is delayed, greater intensity and lasts > 2 years. More likely where:
– Relationship with the deceased was difficult
– Sudden death
– Normal grieving was constrained (e.g. putting on a brave face for the children)
Management – CBT
